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IHA Regulatory Chart

Payment System Regulation

Description

Links and Resources

Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH)

Regulation to update Medicare payment policies and rates under the IPPS and LTCH PPS.

 

Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC)

Regulation to update Medicare payment policies and rates under the OPPS and ASC PPS.

 

 

Physician Services Regulation

Description Links and Resources

Physician Fee Schedule

Regulation to update payment policies and rates under the Physician Fee Schedule

Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models

Implements provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) related to the new physician payment system: the Merit-based Incentive Payment System and alternative payment models.

Other Rules Description Links and Resources
Medicare Reporting of Overpayments

Requires Medicare Part A and B providers to report and return overpayments.

Accountable Care Organization Performance Measures Makes technical changes to the way financial targets are calculated for accountable care organizations in the Medicare Shared Savings Program.
Medicaid Drug Rebates Implements an Affordable Care Act (ACA) provision concerning the Medicaid drug rebate program and reimbursement for covered outpatient drugs. 

Medicaid and CHIP Managed Care

Regulation to update policies under Medicaid managed care.